TAP CHf Y DUOC LAM SANG 108 Tap 12 - S6 4/2017
Phan tich mot s6 ylu to lien quan din r6i loan tram cam &
benh nhan ton thuo'ng tuy song
Analyze some related factors with depressive disorder in the patients with spinal cord injury
Nguyin Thi Kim Li§n, Nguyen Van Tukn Trucmg Dgi hoc YHa Ngi
Tom tSt
Mucf/eu;Tim hieu mpt so yeu to lien quan den roi loan tram cam dbenh nhan ton thuong tu;^song.
Doi tugng vd phuang phdp: Nghien cu'u tren 94 benh nhan tdn thuong t u j song di^u tn tai Trung tam Phuc hoi churc nang B^nhvien Bach Mai tCri 1/2015 den 09/2016 bang phuong phap nghien ciJu mo ta eat ngang. Ket qud: Khong co sU khae biet ve t? le benh nhan t6n thuong tuy song eo roi loan tram cam theo gi6i, trinh dp hpc van, ngh^ nghiep, nguyen nhan ton thUflng, vj tri tdn thuong, mu'c do dau va mu'c dp dpc lap trong sinh hoat hang ngay theo SCIM. Cac yeu to eo lien quan den roi loan tram cam 6 b^nh nhan tdn thuong t u j ' sdng la: Tuoi {cang tre nguy cO cang cao, p=0,023), tinh trang hdn nhan (ehUa k^t hon CO nguy cO cao hOn, p=0,005) va mufc do tdn thuong tuj" song theo phan loai ASIA {cang nang nguy co cang cao, p=0,031). Ket ludn: Cac yeu td eo lien quan den roi loan tram cam d b&nh nh^n ton thuang Xuji sdng la: Tudi, tinh trang hdn nhan va mijfc dp tdn thUOng tuy sdng theo phan loai A5IA.
Tdkhda:Tr^rr\ cam, roi loan tram c^m, ton thuong tuy song, y^u t d lien quan.
Summary
Objective: To analyze the related factors with depressive disorder in the patients with spinal cord injury. Subject and method: 94 in-patients with spinal cord injury at Rehabilitation Center Bach Mai Hospital from November 2015 to September 2016 by the cross-sectional study. Result There was no correlation between the rate of spinal cord injury patients with depressive disorder by gender, education level, occupation, cause of injury, damage location and level of pain and level of spinal cord independence (5C1M). The factors, which related to depressive disorders in spinal cord injury patients are; Age (the younger the higher risk, p=0.023), marital status (unmarried higher risk, p=0.005) and level of cord injury live by sorting ASIA (the more serious the higher the risk, p=0.031). Conclusion: The factors, which related to depressive disorders in the patients with spinal cord injury are: Age, marital status and injury level in ASIA.
Keywords: Depression, depressive disorder, spinal cord injury, related factor.
Ngdy nhqn bdi. 14/03/2017, ngdy chap nhdn dang: 23/03/2017
Ngudi phdn hoL Nguyen Th( Kim Lien, Email: [email protected] - Trudng Dai hoc Y HdNoi
JOURNAL OF 108 - CLINICAL MEDICINE A N D PHARMACY Vol.l2-N=4/a017
1 . Dat van de
Tram cam la rdi loan tam ly thudng gap nhat sau ton thuong tuy sdng. N^u khong dUoe dieu trj, cae trieu ehtjfng tram Ceim co the thanh man tinh va anh hu6ng tieu cUc den chat lUong euoe sdng, d i n den e^e van de sCfc kh6e thiJ phat khien benh nhan pheii nhap vien nhieu lan, ket qua hdi phuc ve mat chufc nang kem, va lam giam tuoi tho mong dpi. Do v | y vi&e sang Ipc va lUpng gia cae roi loan tam ly noi chung va rdi loan tram c^m noi riSng sau ton thuong tuy sdng la can thiet va ngay cang di/pe chu trpng.
Nghien cufu tim hi^u yeu t o lien quan den roi loan tram e l m 6 benh nhan ton thuong tuy song de tu" do CO tien lapng, tu" van, ket hop tam ly tri lieu nh^m nang eao hi&u q u i phuc hdi chufc nang, giiip benh nhan tai hoa nhap cpng dong dUOc tot hon la van de can thiet. VI v l y , chiing toi thac hien de tai nay vdi muc tieu Tim hieu mdt so yeu to Hin quan den rdi logn trdm cdm dbenh nhdn ton thuang tu^ sdng.
2. Doi tuong va phUdng ph^p 2.1.06i taong
Ddi tupng nghien cu'u la benh nhan tdn thi/ong tuy sdng dugc dieu tri tai Trung t i m Phuc hdi chufc nang B#nh vien Bach Mai xU 11 /2015 den 09/2016.
Tieu chuan lua chgn
Benh n h i n dupc chan doan t d n thaong tuy sdng; sau tdn thupng tCiy sdng it nhat 1 thang; Xii 18 tudi t r d len, khdng ed ton t h u o n g nao, khong co roi loan tam than trudc d6 va t u nguyen tham gia vao nghien euli.
Tiiu chuan logi trd
Khdng tuan thO dieu trj. Benh nhan co tien sCr dung thude dieu tri rdi loan tam than; eo rdi loan nhan thUc; co benh ly nang kem theo.
2.2. PhUCngphap Thiet kenghien cdu
Md ta c3t ngang, thu thap thdng tin Xii benh an mau, ngudi nha; hdi b^nh, kham lam sang.
Phat hien cae trieu ehifng rdi loan tram cam, chan doan xac djnh rdi loan tram e l m dUa tren lam sang: Sxi dung tieu chuan chan doan tram e l m theo ICD-10 chan doan giai doan tram cam dien hinh [1]
vdi eae trieu ehiJng dae trUng {Khf sac giam, mat moi quan t i m thich t h u , g i l m nang lupng dan den tang m6t mdi va giam hoat dpng).
Phln loai theo ASIA [2] chia tdn thuong tuy song l l m 5 mUc dp: A - Liet hoan toan: Khdng co chiJc nang van dpng hoae c5m giac dupe bao tdn d doan tuy eung S4-S5; B = Liet khong hoan toan: Con Ccim giac nhung khdng eon chUc nang van dpng dugc bao tdn ben dudi mUc tdn thuong than kinh va bao gom doan tuy cung S4-S5; C = Liet khdng hoan toan: Chu'c nang van dpng dupe b i o ton ben dudi mUe than kinh, v l hon mpt nUa sd eO chO chdt dudi moi mile tdn thuong than kinh cd eo lUe nhd hpn 3. D = Liet khdng hoan toan: ChUc nang van ddng dugc bao ton ben dudi mUc than kinh,va ftnhatmptnUasdeochu chdt ben dudi mUe ton thUong than kinh co co li/c Idn hon hole bang 3. E = Blnh thudng.
Stf dung thang diem PHQ-9 danh gia mUc do trieu chu'ng rdi loan tram cam [3]: Gdm 9 eau hdi, dUa v I o 9 tieu chuan chan doan tram cam cOa DSM- IV. Diem cOa eac eau hdi dao ddng Xii 0 {khdng c6), 1 (vai ngay), 2 (hon mpt nUa sd ngay), va 3 (hau nhi/
hang ngay). Tdng diem tU 0 den 27 diem, trong do:
<, 4: Khdng ed h o l e ed trieu chUng tram cam toi thieu; 5 - 9 : Trieu ehUng tram e l m mUe dp nhe; 10- 14: Trieu chu'ng tram e l m mUc dp trung binh; 15 - 19: Tri^u chihig tram cam mUc dp trung binh - nang;
a 20: Trieu ehUng tram cam mUc dp nang.
Banh gia tinh trang dpc lap chUe n l n g theo SCIM {Spinal Cord Independence Measure) phien b i n III [4]: Cham sde ban t h i n (0 - 20 diem); hd hap va CO that (0 - 40 di^m); di chuyen (0 - 40 diem).
Tong diem SCIM-III toi da la 100 diem, diem sd cang cao mUe dp doe lap eua b&nh nhan cang cao.
Phuang phdp chgn mau: T h u I n tien.
Phuang phdp xd ly so lieu: Thong ke y hpc bang phan mem SPSS 16.0.
Bao ddc trong nghiin cdu: Nghien eUu dupe thiet ke d i m bao yeu eau ve dao dUc tren co sd: BUpc tien hanh dudi su chap n h i n cCia Ban Giam doc Trung tam Phuc hdi chdc nang, Benh vien Bach Mai. Viec thu thap thdng tin dUa t r i n sU chap nhan eCia ddi tUpng nghien cu'u, tdn trpng hanh phuc, quyen, long tin, nhan thUc, phong tuc tap quan cOa b&nh nhan tham gia. Ludn dat pham gia va sUc khde cQa benh nhan nghien cdu len tren muc dich nghien cufu.
TAP CHf Y Dl/pC LAM SANG 108 TSp12-Sd 4/2017
3. K^t qud
3.7. Dac m4m doi tUc/ng nghiin cOu Ty le benh n h i n nam chiem 73,4%, nhieu hpn nO;
tudi trung binh la 38,8 ± 13,8 {nam tudi), ehu yeu d dp tudi lao dpng 18 - 60 tudi (91,5%). Nguyen nhan tdn thUPng tDy song chu yeu la do c h i n thuong (77,7%);
trong dd nguyen nhan tai nan giao thdng va tai nan lao ddng ed tl \i eao nhat lan lupt la 34,0% va 30,9%.
Trong nhdm nguyen nhan khdng do chan thUPng, v i i m tuy chiem t i le eao nhat 10,6%. Ve vj trf ton thuong, tdn thuong tuy ed {tren D2) gay liet tU ehi chi^m 41,5%; benh n h i n liet hai chan chiem 58,5%
trong dd tdn thuong tU L2 den DIO chiem 35,1%.
3.2. Phan tich mot soy4u tSlien quan 0en roi loan tram cim 3.2.1. Tuoi, gidi, trinh do hgc vdn, nghe nghiep, tinh trgng hdn nhdn
Tuoi
18-25 2 6 - 3 5
3 6 - 4 5
4 6 - 6 0
> 6 0 Tong
Bang 1 . Tram cam va tuoi Tram cdm
Co n 9 8
1
2
1 21
%
45,0 28,6
5,9
9,5
12,5 22,3
Ktiong n 11 20
16
19 7 73
%
55,0 71,4
94,1
90,5 87,5 77,7
OR (Cl 95%)
1 0,49 (0,245-1,682)
0,08 (0,008 - 0,925)
0,13 (0,011 - 0,929)
0,17 (0,111 - 0,994)
P
0,14
0,01 0,01
0,02 0,023
Su khae biet ve t y l i trSm cam gida eae nhdm tudi la ed y nghTa thdng ke (p=0,023). Md hinh hdi quy logistic don bien cho thay nhdm 26 - 35 tudi cd nguy eo bj tram e l m thap hPn so vdi nhdm 18 - 25 tudi, bSng 0,49 lan. Tuy nhien, mdi lien quan I I khong ed y nghTa thdng ke {vdi OR = 0,49,95% Cl: 0,245 -1,682, p>0,05).
Nguy eo bj tr^m e l m d cae nhdm tudi cdn lai la 36 - 45 tudi, 46 - 60 tudi va nhdm tren 60 tudi t h I p hon so vdi nhdm 18 - 25 l l n lupt la 0,08; 0,13 va 0,17 lan (OR lan lUpt la 0,08; 0,13 va 0,17). Mdi l i i n quan nay la ed y nghTa t h d n g k i (Cl 95% l l n lUpt la 0,008 - 0,925; 0,011 - 0,929 va 0,111 - 0,994; p<0,05).
Bang 2 . Tram cdm va gidi
Gidri Nam NO
TrSm c^m n 16 5
%
23,2 20,0
Klidng tram cSm n
53 20
%
76,8 SO
Tong n 69 25
%
100 100
P
0,743
SU khIe biet ve ty le tram cam d benh nhan nam va nU khdng cd y nghTa thdng k i vdi p=0,743.
JOURNAL OF 108 - CUNICAL MEDICINE AND PHARMACY Vol.12-N='4/2057
Being 3. Tram cam v^ trinh 36 hoc van
Hoc van
Khong di hoc Cap 1 den het cap 2 Het cap 3 hoac trung cap Cao dSng hoac dai hoc
Tong
Tram cSm Co
n 1 6 7 7 21
%
4,8 28,6 33,3 33,3 100
Khong n 4 32 23 14 73
%
5,5 43,8 31,5 19,2 100
P
0,436
SU khae biet ty^ l i tram e l m d cac doi tupng benh nhan cd trinh dp hpc van khac nhau la khdng co y nghTa thdng k i vdi p=0,436 (p>0,05}.
Bang 4. Tram cam va nghe nghiep
Nghe nghiep
Nong dan Cong nhan Kinh doanh Trithijrc Khac
Tong
Tram cSm Co
n 3 7 2 4 5 21
%
14,3 33,3 9,5 19,0 23,8 100
Khong n 23 15 9 14 12 21
%
31,5 33,3 9,5 19,0 23,8 100
P
0,472
SU khae biet ve t l l i tram e l m giufa cae nhdm nghe n g h i i p la khdng ed y nghTa thdng k i vdi p=0,472.
Bdng 5. Tram cSm va tinh trang hon nhan
Tmh trang hon nhan
Chua k^t hon Da k^x hon Lyhon Gda
Tram ciim Co
n 10 11 0 0
%
43,5 15,9 0 0
Khong n 13 58 1 1
%
56,5 84,1 100 100
OR (Cl 95%)
1 0,24 (0,08-0,71)
P
0,005
Md hinh hdi quy logistic don bien eho thay nhdm b i n h n h i n da ket hon cd nguy eo bj tram cam thap hon 0,24 lan so vdi nhdm ehUa k i t hdn. Mdi l i i n quan la ed y nghTa thdng ke vdi OR = 0,24, Cl 95%: 0,08 - 0,71,p<0,05.
TAP CHf Y Dirqc LAM SANG 108 Tapl2-S64/2017
3.2.2. Trdm cdm vd thdi gian ton thuang tuy song
Bdng 6. Tram cdm va thc^ g i a n t o n t h u o n g tOy song
Tholi gian 1 - 3 thang
< 3 t h a n g - 6 thang
< 6 thang d^n 1 nam 1 - 5 nam
>5nanri Tong
Tram cSm Co
n 13 4 3 1 0 21
61,9
%
19,0 14,3 4,8 0 100
Khong n 47 10 5 8 3 21
64,4
%
13,7 6,8 11,0 4,1 100
p
0,643
Ty le benh nhan b| tram cam d nhdm ed thdi gian ton thuong trong vdng 1 - 3 thang chiem t y le eao nhat {61,9%). Khdng ed benh nhan nao tren 5 nam bi tram e l m . SU khac b i i t ve X^ le tram e l m giufa eac nhdm benh nhan ed thdi gian bi tdn t h u o n g tuy sdng khae nhau la khdng ed y nghTa thdng ke (p>0,05).
3.2.3. Trdm cdm vd vi tri ton thUang
Bang 7. Tram cdm va vj t r i t o n thUcfng
v j t r i t o n t h u o n g Tren 0 2
D 2 - D 9 D10-L2
Tong
Tram cSm Co
n 6 4 11 21
28,6
%
19,0 52,4 100
Khong n 33 17 23 21
45,2
%
23,3 31,5 100
P
0,206
SU khIe biet ve ty' le tram cam theo vj tri tdn thuong khdng cd y nghTa thdng ke vdi p=0,206.
3.2.4. Trdm cdm vdmdcdg ton thuang tdy song theo phdn logi ASIA
Bdng 8. Tram cdm va mUc do t o n thUOng tOy song t h e o p h a n loai ASIA
Phan loai ASIA ASIA A ASIAB ASIAC ASIAD
Tram cdm Co
n 14 3 2 2
33,3
%
37,5 8,7 9,5
Khong n 28
5 21 19
66,7
%
62,5 91,3 90,5
OR (Cl 9S%)
1 1,2 (0,25 - 5,87)
0,19 (0,04-1,00)
0,21 (0,04-1,11)
P
0,821 0,029 0,042
0,031
SU khac biet ve tjr le tram cam theo mu'c do t6n t h u a n g tuy song la co y nghTa thong ke v i i p=0,031.
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY VoL12-N''4/2017
Nguy co bi tram cam d nhdm benh nhan ASIA B eao hon b i n h nhan ASIA A (a 1,2 lan nhUng mdi liin quan nay khdng ed y nghTa thdng ke vdi OR = 1,2; Cl 95%: 0,25 - 5,87. Nguy CO bi tram e l m d nhdm benh n h i n ASIA D thap hon b i n h n h i n ASIA A I I 0,21 lan nhung moi lien quan nay khdng ed y nghTa thdng ke vdi OR = 0,21;CI 95%: 0 , 0 4 - 1 , 1 1 . Nguy CO bj tram cam d nhdm benh nhan ASIA C thap hon nhdm benh nhan ASIA A 0,19 lan. Mdi lien quan nay cd y nghla thdng ke (OR = 0,19; Cl 95%: 0,04 -1,00, p<0,05).
3.2.5. Trdm cdm vd mdc dd dau sau ton thuang tdy song
Bdng 9. Tram cdm va mUc do dau sau ton thuong tuy song
Mt}c do dau
Khong dau Nhe Vto Nhi^u
T^ng
Tram cam Co
n 1 5 14 1 21
4,8
%
23,8 66,7 4,8 100
Khong n 3 33 33 4 21
4,1
%
45,2 45,2 5,5 100
P
0,244
SU khae biet ve tJ' le roi loan tram e l m theo mUe dp dau la khdng ed y nghTa thdng ke (p>0,05).
3.2.6. Trdm cdm vd mdc do dgc lap trong sinh hogt hdng ngdy
Bdng 10. Tram cam va mUc do doc lap trong sinh hoat hang ngay Nhom
Diem SCIM trung binh
Tram cdm
52,67 ± 24,04 Khong co tram cdm 58,16 ±22,35
P 0,717 Khdng cd sU khac biet diem SCIM trung binh giUa nhdm tram cam va khdng tram cam (p>0,05).
4, Ban luan
TJ" l i tram cam khdng ed sU khae biet ve gidi tinh, trinh dp hpc van, nghe nghiep, vi tn' ton thuong, nguyen n h i n ton thuong v l thdi gian tdn thuong cung nhu mUe dd dau sau tdn thuong tOy song. Ket qua nay cung tUOng tU nhU nghien eUu Bombardier CH (2004) v l nhieu n g h i i n cdu khae [5], [6].
Cd mdi lien quan giCfa tram e l m va tudi, tinh trang hdn nhan va mde dp ton thuong tQy sdng (theo phan loai ASIA). Trong nghien cUu eua chiing tdi, nhdm tudi 18 - 25 la nhdm ed nguy ccf tram e l m
eao nhat, eac nhdm tudi 35 - 45, 46 - 60 va tren 50 tudi cd nguy co thap hon nhdm tuoi 18 - 25 lan lucft la 0,08,0,13, va 0,17 lan; ve tinh trang hdn nhan tram d m gap nhieu d nhdm benh n h i n ehUa ket hdn va ve mdc dp tdn thuong tuy sdng theo p h l n loai ASIA thi benh nhan cd p h l n loai ASIA A ed nguy co tram cam cao nhat, benh nhan ASIA C va ASIA D ed nguy CO tram e l m lan lUpt I I 0,19 va 0,21 lan so vdi benh nhan ASIA A. Theo Bombardier (2004), tram cam gap nhieu nhat d nhdm 25 - 49 tudi, benh n h i n da ket hdn hoac ly t h i n , ly hdn hoac goa chiem tJ le cao han v l khdng ed su khae biet ve rj" le tram cam theo mdc dd tdn thuong tCiy sdng giCfa benh nhan tdn thUcfng h o l n toan {ASIA A) v l khdng hoan toan (ASIA B, ASIA C, ASIA D) [5]. SU khac biet giCfa 2 nghien eUu cd t h ^ giai thich do cd mau nghien cuU khae nhau ddng thdi trong n g h i i n cdu cua chiing tdi ehi ed 1 benh nhan ly than va 1 benh nhan goa do vay ket q u i nghien edu bj I n h hUdng.
Chung tdi sd dung thang diem SCIM-III de lupng gia chdc nang eho benh nhan tdn thuong tuy sdng.
Bombardier CH (2004) dCing thang di^m FIM (Functional Independent Measure). Thang diem SCIM-III nhay hon FIM trong phat hien thay ddi chile nang d b i n h nhan t d n thuong tuy sdng va I I thang diem duac sd dung rdng dai trong lupng gia chdc
TAP CHI Y Dl/pc LAM SANG 108 Tapl2-S6 4/2017
nang sinh hoat hang n g l y d benh nhan tdn thuong tuy sdng [7]. Ket q u i d ea 2 nghien cUu deu dUa d i n ket luan khdng ed su khac b i i t ve ty l i tram cam theo k h i nang dpc lap trong sinh hoat hang ngay.
Benh nhan tdn thUPng tuy sdng tU D l t r d l i n tUOng dng t r i n lam sang la liet t d ehi ed nguy co tr^m e l m tUdng duong vdi nhdm benh nhan Hit hai chan la nhdng b i n h nhan t h u d n g ed diem SCIM-III cao hon.
K i t q u i nay di ngUpe lai vdi suy doan thdng thudng nhung da dupc ehdng minh d nhieu nghien edu [5].
5. Ket ludn
Cae yeu t d ed lien quan den rdi loan tram e l m d benh nhan tdn thUdng tuy sdng:
Tudi: Cang tre nguy eO cang eao.
Tinh trang hdn nhan: ChUa ket hdn ed nguy cO cao hon.
Mde dp t d n t h u o n g tuy sdng theo p h l n loai ASIA: Cang nang nguy eO cang cao.
Tai lieu t h a m khdo
1. Wold Health Organization (WHO) (1992) The ICD 10. Geneva.
2 Middleton J, Siddall P and PKN {2008} Managing Pain for Adults with Spinal Cord Injury. New South Wales State Spinal Cord Injury Service.
3. Model System Knowledge Translation Center and t. N. 1. o. D. a. R. Research (2008) Spinal cord Injury (SCI) and Depression Measures. University of Washington 10.
4. Bluvshtein Vet al (2011) SCIM ill is reliable and valid in a separate analysis for traumatic spinal cord lesions. Spinal Cord 49:292-296.
5. Bombardier CH, Richards JS et al (2004) Symptoms of major depression in people with spinal cord injury:
Implications for Screening. Arch Phys Med Rehabil 85:1749-1756.
6. Bombardier CH, Fann JR et al (2012) An exploration of modifiable risk factors for depression after spinal cord injury: Which Factors Should We Target? Arch Phys Med Rehabil 93:775-781.
7. Catz A, Itzkovieh M et al (1997) SCIM - spinal cord independence measure: A new disability scale for patients with spinal cord lessions. Spinal Cord 35:
850-856.
